The Care Quality Commission
  • Doctor
  • GP practice

Archived: Dr Andreas Sampson

Overall: Inadequate read more about inspection ratings

The Surgery, 625 Green Lanes, Hornsey, London, N8 0RE (020) 8340 6898

Provided and run by:
Dr Andreas Sampson

All Inspections

10 March 2016 & 24 March 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Andreas Sampson (also known as the ‘The Surgery’) on 10 March 2016 and 24 March 2016. Overall the practice is rated as inadequate.

At the time of the inspection, the practice’s patient list consisted of six NHS patients. The staff team consisted solely of Dr Andreas Sampson.

We were advised that the practice did not participate in the national GP patient survey or QOF (a system intended to improve the quality of general practice and reward good practice). We were shown a range of policies and procedures; and shown a patient survey completed in 2015 as part of Dr Sampson’s annual appraisal. We were told that all patient records were paper-based.

However, we were declined access to patient records and the opportunity to ask patients (via comment card or in person) for their views about care and treatment; although we explained our rationale for looking at patient records. This hindered our lines of enquiry such that we were unable to provide a rating for the six population groups.

Our report is therefore based upon Dr Sampson’s feedback and upon a review of the available policies; and has not been corroborated by a review of patient records.

We have not been able to assure ourselves that people were being protected from avoidable harm, that people’s care and treatment was optimised and that people were being treated with care and compassion.

Our key findings across all the areas we inspected were as follows:

  • There was no evidence of recording and learning from significant events. For example, we had previously inspected the location in 2014 and identified infection prevention and control (IPC) concerns. There was no record of the concerns having been logged as a significant event or of learning being shared with a GP provider based in the same building which shared IPC processes. No significant events had been recorded since July 2014.

  • There were inadequate plans in place to manage risks associated with emergency situations. For example, we were told that the GP had access to the emergency medicines of the GP provider based in the same building but the provider’s staff told us that no such arrangement was in place.

  • Patient outcomes were hard to identify. For example, there was little reference made to quality improvement and there was no evidence that the practice was comparing its performance to others; either locally or nationally.

  • Two clinical audits had been undertaken in the last two years but it was unclear how they had been used to drive improvements to patient outcomes. They were not completed audit cycles.

  • Some people who used the service had concerns about how they were treated. For example, NHS Choices feedback was not positive regarding levels of compassion and dignity.

  • Governance arrangements were unclear. For example, the practice had a list of policies and procedures used to govern activity but some lacked sufficient detail.

The areas where the provider must make improvements are:

  • Ensure that there are appropriate systems in place to review governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.

  • Ensure that clinical equipment is regularly checked.

  • Ensure that the GP undertakes annual basic life support training.

  • Undertake a risk assessment of the range of emergency medicines carried on home visits.

In addition the provider should:

  • Review systems in place for receiving and acting on patient safety alerts.

  • Review the chaperone policy to ensure that is fit for purpose.

  • Review arrangements for out of hours cover.

  • Ensure that the practice’s safeguarding policy contains details of how to contact relevant agencies in normal working hours and out of hours.

  • Install a privacy curtain in its consulting room to maintain patients’ privacy and dignity during examinations, investigations and treatments.

  • Provide information to help patients understand the services available to them.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

30 July 2014

During an inspection looking at part of the service

At our inspection of 11 February 2014 we found that people were not always cared for in a clean and hygienic environment because the nurse's room and minor surgery rooms were dirty. The floor in the nurse's room was not well fitted to the edges of the room leaving space for collection of dirt and bacteria. We also found that the provider did not have sufficient systems in place to seek the views or feedback from the people who used the service. The provider sent us an action plan stating that the necessary improvements would be made by 23 June 2014.

Our inspection on 30 July 2014 found that the provider had made improvements. They had contracted a cleaning company to carry out daily cleaning of the premises. The provider told us that the flooring was in the process of being replaced and records confirmed this.

At the time of our inspection, the provider had six patients on their list. The provider had carried out a patient survey in April 2014 to allow their patients to provide them with feedback. They told us that they used this feedback to improve on the services provided.

11 February 2014

During an inspection in response to concerns

People spoke positively about the extent to which they were involved in decisions about their care and the dignity and respect they received. Comments included, "he's very caring' and 'he's got that very good, typical doctor-like approach and is very sensitive in his approach'. People said their care and support was explained to them and staff took account of their diverse needs.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

There were shortfalls in the management of infection control and as a result, people were not always cared for in a clean, hygienic environment. Medicines were managed effectively.

The provider talked with people to try to understand what their experience of the service was. However, there were shortfalls because the system to seek people's views was not sufficiently robust.

The service shared a location address with another doctor who was separately registered. The provider shared administrative, reception and other systems, policies and procedures and was in the process of discussing the possibility of merging with the other doctor's practice.